'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

Babylon GP appointment app raises fears of patients 'gaming' system

CCGs in London have decided not to proceed with plans to use Babylon Health’s 'symptom checker' app to triage patients after testing revealed there was a risk of 'gaming the system to achieve a GP appointment'.

The app uses artificial intelligence to ask patients questions about their illness using a 'chat bot' interface before directly booking patients in for a GP video consultation, if necessary.

But according to board papers from a London CCG - first reported by HSJ - instead of reducing GP attendance, testing of the app raised a concern that patients who used the app may do so to get faster access to a GP appointment.

According to CCG board papers from the North West London CCGs Collaboration Board published earlier this month (and recently updated - see box below), the initiative - run by Babylon - was tested with focus groups to 'to see if the technology could drive reductions in demand for GP appointments'.

The paper says: 'Work over the summer with focus groups to gather insights around perceptions had raised a concern that patients who might use the app could mainly do so because they believed it would get them faster access to GP appointments.

'The focus groups had also commented that there is a risk of some people gaming the symptom checker to achieve a GP appointment.

'The insights gathered therefore revealed that the symptom checker in particular was unlikely to reduce demand on GP services. This reduced the intended benefit of the system significantly. Following questions and further discussion, the Board agreed not to proceed to the pilot stage.'

A spokesperson for the CCGs said: 'The CCGs considered the merits of this app as a tool to help manage demand on GPs – particularly through the symptom-checker feature.

'We worked closely with patients to find out what demand there was for the app. We found that patients were typically most interested in using the app to speed up GP access, rather than the symptom checker.

'In the end, the information gathered from talking to patients was successful in informing the ongoing work of the sector as we explore this area further.'

A joint statement from Imperial College Health Partners (ICHP), Health Education England in North West London and Babylon said: 'We worked in partnership with the North West London Collaboration of CCGs and Health Education England working across North West London, to consider the merits of the app as a tool to help manage demand for GP services – particularly through the symptom-checker feature.

'We worked closely with patients and the public to find out what demand there was for the app. We found that patients were typically most interested in using the app to speed up GP access, rather than the symptom checker.

'The insights gathered from engaging with patients and the public was sufficient in informing the ongoing work of the sector as we explore this area further.'

The paper from the CHWECCG group said that ‘17 pioneer GP practices’ along with Imperial College Health Partners and Health Education England are ‘all working to develop an alternative’.

It said: ‘During November 2017, GPs are being invited to give input on the next steps and how we might shape digital access to general practice.’

Please note:

This story was amended at 11:45 on 22 November 2017 after Pulse was made aware that the CCG board papers incorrectly said the app was piloted.

This story and headline were amended at 11:05 on 23 November 2017 to remove references that the pilot group had 'manipulated' the app after Pulse was alerted that the CCG had changed their minutes to different wording.

Some 20-25 years ago I started asking the receptionists to mark those booked patients who might benefit from a telephone call rather than a surgery consult. Then with a spare 30-40 minutes in the afternoon I would telephone the following mornings list and managed to deal with 3 or 4 of those freeing up appointments.

Fine for a week or two then the patients adapted. Telephones were left unanswered or engaged. The more inventive developed rashes or bizarre symptoms necessitating seeing them.

The free spaces disappeared. The telephone calls fell by the wayside.

It seems that whatever AI app style triage you might want to develop they will adapt. Resistance is futile.

The only thing which will 100 % work is when people start paying (contribute) to their GP/Hospital appointment. Rest all other initiative are pure nonsense. I wonder when will our leaders and government accept it.

Dear All,Suprise suprise, patients manipulate the system the gain access, have done since 1948. Suprise, suprise, suprise, lowering the threshold for gaining access to nothing more than a swipe of an icon on a screen and correctly answering some AI (sic) questions does not reduce workload, suprise, suprise, suprise, suprise, NHS managers didn't think of this.RegardsPaul C

I cannot help but laugh. This is so predictable those goons even thought it would work. Patients are and will always manipulate the system especially when it is free. The only way is to make them pay for what they use.